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BackgroundHigh intracranial pressure (ICP) is one of the most common complications of central nervous system (CNS) infection. Failure to control high intracranial pressure results in brain herniation and death. One of the treatments for high ICP involves the administration of osmotherapy in the form of 3% NaCl or 20% mannitol with observation during administration. Observation of ICP during administration of osmotherapy is possible through measurement of optic nerve sheath diameter (ONSD), which could be correlated with degree of consciousness, pupil diameter, and light reflex. Previous studies have not correlated ONSD with degree of consciousness, pupil diameter, and light reflex during the administration of osmotherapy.PurposeTo provide insights of incorporating ONSD measurement as a form of non-invasive bedside method for ICP monitoring by correlating it with degree of consciousness, pupil diameter, and light reflex at several time points.MethodsThis study is a prospective cohort study, performed at Dr. Hasan Sadikin General Central Hospital Bandung, Cibabat General Regional Hospital, and General Regional Hospital Bandung Kiwari on children aged 2–18 years with decreased consciousness and CNS infection, from June 2023. Inter-rater reliability was performed with a correlation coefficient of 0.90. Measurement of ONSD, degree of consciousness, pupil diameter, and light reflex simultaneously up to 48 h after initiation of osmotherapy to 30 patients. Correlational analyses were performed using Spearman's rank.ResultsObservation for 48 h after administration of osmotherapy showed changes in ONSD. A significant positive correlation was found between ONSD and degree of consciousness (r = 0.621 for the right eye and r = 0.602 for the left eye, p 0.05).ConclusionA significant correlation was found between ONSD and degree of consciousness and light reflex in children aged 2–18 years with CNS infection during administration of osmotherapy.

Abstract Objective Duchenne/Becker muscular dystrophy (DMD/BMD) is the most common genetic neuromuscular disease in children, resulting from a defect in the DMD gene located on Xp21.2. The new emerging treatment using exon skipping strategy is tailored to specific mutations, thus molecular diagnostics are particularly important. This study aimed to detect the DMD gene deletion in Indonesian DMD/BMD patients and analyze the potential amenability by exon skipping therapy. Results Thirty-four male patients were enrolled in this study, 23 of them (67.6%) underwent muscle biopsy and showed the absence or partially expressed dystrophin protein in immunohistochemistry staining. All patients had very high serum CK levels (10.529 ± 9.97 IU/L). Multiplex PCR revealed the DMD gene deletions in 15 (44.1%) cases. Seventy-eight percent of deletions were clustered in the hot-spot region of exon 43 to 52. Furthermore, seven (20.5%) patients were potentially amenable to exon skipping treatment. Therefore, multiplex PCR is one feasible method to detect DMD gene deletion in Indonesian DMD/BMD patients that can further determine the potential amenability of exon skipping therapy. In addition, this study is the first report of DMD gene deletion analysis in Indonesia.

Latar belakang. Epilepsi masih merupakan penyakit yang banyak diderita masyarakat di seluruh dunia. Limapuluh juta orang diperkirakan menderita epilepsi di seluruh dunia dengan angka insiden tahunan berkisar 20–70 kasus per 100 000 penduduk, dan angka prevalensi 0,4%–0,8%. Prevalensi epilepsi yang tinggi secara langsung akan berimbas penggunaan asam valproat tinggi, dan dapat meningkatkan risiko dampak hepatotoksisitas. Tujuan. Mengetahui hubungan antara usia, status gizi, lama terapi dengan kejadian hepatotoksisitas pada anak epilepsi yang mendapatkan terapi asam valproat. Metode. Penelitian desain potong lintang. Data diambil pada bulan September – November 2011 di RSUP DR. Sardjito, Yogyakarta. Kriteria inklusi adalah anak epilepsi usia

Latar belakang. Gangguan Pemusatan Perhatian/Hiperaktifitas (GPP/H) merupakan gangguan neurobehavioural yang menetap dengan gejala berupa ketidakmampuan memusatkan perhatian, hiperaktivitas, dan impulsivitas yang tidak sesuai dengan usia perkembangannya. Tujuan. Mengetahui perbedaan angka prevalensi dan karakteristik faktor risiko yang menimbulkan GPP/H di pedesaan dan perkotaan. Metode. Penelitian potong lintang untuk mengetahui prevalensi GPP/H dan dilanjutkan studi kasus kontrol untuk memperoleh faktor risiko yang memengaruhi terjadinya GPP/H di pedesaan dan perkotaan. Subyek penelitian terdiri dari anak SD kelas I – III. Hasil. Prevalensi GPP/H di kecamatan Cangkringan 7,48% dengan rasio prevalensi GPP/H antara laki-laki dan perempuan 6 : 1. Prevalensi di pedesaan 46% dan perkotaan 54%. Hasil analisis bivariat menunjukkan perbedaan faktor risiko yang berpengaruh di pedesaan dan perkotaan adalah keluarga hiperaktif, komplikasi kehamilan, serta konsumsi makanan berpengawet dan berpewarna lebih tinggi di perkotaan. Sedangkan durasi interaksi dengan orang tua

Latar belakang. Salah satu faktor risiko kejang demam adalah riwayat kejang pada keluarga, dihubungkan dengan tipe kejang demam pertama dan usia saat terjadi kejang demam pertama. Beberapa penelitian menunjukkan riwayat kejang meningkatkan risiko kejang demam kompleks sebagai tipe kejang demam pertama dan berhubungan dengan usia kejang demam pertama yang lebih dini. Tujuan. Mengetahui hubungan riwayat kejang pada keluarga dengan tipe kejang demam pertama dan usia saat kejang demam pertama. Metode. Penelitian dilaksanakan di Bagian Ilmu Kesehatan Anak RSUP Dr. Sardjito,Yogyakarta sejak Januari 2009-Juli 2010. Pengambilan sampel dilakukan secara konsekutif dan dikelompokkan berdasarkan ada tidaknya riwayat kejang pada keluarga, tipe kejang demam pertama, dan usia saat terjadi kejang demam pertama. Hasil. Seratus lima puluh anak usia 6 bulan–5 tahun yang memenuhi kriteria inklusi dan eksklusi diikutsertakan dalam penelitian. Terdapat 91 (60,6%) anak yang mempunyai riwayat kejang pada keluarga dan kejang demam pertama terjadi pada usia yang lebih dini pada kelompok ini (median usia 13,0 vs 17,0 bulan; IK95%: 0,00-0,03; p=0,01). Anak dengan riwayat kejang lebih banyak mengalami kejang demam sederhana dibandingkan kejang demam kompleks (61,4% vs 59,2%), meskipun perbedaannya tidak bermakna (IK95%: 0,78-1,37; p=0,80) Kesimpulan. Anak dengan riwayat kejang pada keluarga cenderung mengalami kejang demam pertama pada usia yang lebih dini. Riwayat kejang pada keluarga tidak meningkatkan risiko terjadi kejang demam kompleks sebagai tipe kejang demam pertama.

Congenital obstructive posterior urethral membranes (COPUM) is a complex disease closely related to several pathological changes in kidney development and function, as a result of urinary reflux since in utero. This congenital anomaly of urinary tract potentially causes hydroureteronephrosis that is often associated with recurrent urinary tract infections and, ultimately, one of the most common causes of end-stage renal disease in children.1,2 Congenital hypertrophy of the verumontanum as part of COPUM is very rare. Only a few reports have been written on congenital hypertrophy of the vermontanum causing congenital obstructive uropathy.3-6

Background Seizures in neonates are often associated with neurological disorders in early life, including epilepsy. Several possible prognostic factors may influence the development of epilepsy in these patients. Objective To evaluate prognostic factors that may influence the occurrence of epilepsy in the first two years of life in patients with a history of neonatal seizures. Methods We performed a cohort retrospective study on patients with neonatal se izures in Sardjito Hospital during 2004-2009. Prognostic factors observed were gender, family history of epilepsy, neonatal hypoglycemia, assisted labor, hypoxic ischemic encephalopathy, preterm infant delivery, and epileptic state. Results Hypoxic ischemic encephalopathy and epileptic state increased the risk of epilepsy (HR 5.8; 95%CI 1.63 to 20.43 and HR 6.3; 95%CI 2 .0 to 19. 70, respectively). Assisted labor, preterm delivery, neonatal hypoglycemia, family history of epilepsy, and gender did not increase the risk of epilepsy in the first two years of life. Conclusion Hypoxic ischemic encephalopathy and epileptic state in neonates presenting with seizures are the prognostic factors to be epileptic children during the first two years of life.

Background The overall incidence of birth related injuries declines with the improvement in obstetrics. However, the incidence of head trauma in infants after massaged by a traditional birth attendant (TBA) is still unknown. Objective To study the characteristics of intracranial hemorrhage in infants after massaged by a TBA. Methods A retrospective study was conducted in Sardjito Hospital, Yogyakarta, Indonesia between October 2001 and May 2005. Infants with intracranial hemorrhage after massaged by a TBA were included. Data on patients’ demography, history of massaging by TBA, clinical presentation, and injury characteristics such as anemia, clotting time (CT), bleeding time (BT), prothrombin time (PT) and activated partial thromboplastin time (APTT) were noted. Computed cranial tomography (CT) scans were performed. Results A total of seven infants were diagnosed with intracranial hemorrhage after massaged by a TBA. There were four males and three females (mean age 46 days; range 27-60 days). All infants were referred to Sardjito Hospital, Yogyakarta, Indonesia with bad condition and anemia; mean hemoglobin level was 5.5 g/dl (range 3.7-8.3 g/dl). All infants presented with seizures. Coagulation screening showed normal results in five patients. The remaining patients had a prolonged CT and PT. CT scan showed subdural hemorrhage in four patients, intracerebral hemorrhage in four, epidural hemorrhage in two, and subarachnoid hemorrhage in one. Two patients had chronic hemorrhage, while the rest had acute hemorrhage. Four of them underwent craniotomy, two patients were under an observation only, and one patient was not treated due to parental refusal. Six patients survived and the one who refused to be treated died. Conclusions The parents, midwives, and doctors have to be aware of head massaging since it may harm infants.

Background: Autism spectrum disorder (ASD) is a complex developmental disorder, increasing in number, faster than that of other developmental disorders in the world. This complex disorder affects a child’s self-autonomy, which is important for individual self-care. Objective : This study is to explore main caregivers’ experience to meet self-care needs among adolescents with ASD in Pontianak, West Borneo, Indonesia. Methods: Qualitative semi-structured in-depth interviews were done with 7 main caregivers that have lived together and taken care of the adolescents with ASD in Pontianak Municipality, West Borneo Province. Sampling was taken with purposive sampling (maximum variation). Source (interviews) and method (observations of self-care activities and documents like photos, learning reports and field notes) triangulations were taken on 1 participant and 7 autistic adolescents. Participants’ statements were recorded by using a voice recorder, and then transcribed, coded, interpreted, and categorized in order that sub-topics and main topics could be formed. Results: The study identified five main topics: i.e., 1) Autonomy in self-care; 2) Care effort; 3) Feelings, support, and expectations. Three findings of the study emphasize the potentials of children with autism to be autonomous in daily self-care. Conclusions: Adolescents with ASD can potentially meet the needs of their daily care independently.

Latar belakang. Meningitis bakterialis merupakan salah satu penyebab morbiditas dan mortalitas yang penting pada anak. Anak dengan meningitis biasa datang ke rumah sakit dan mendapat antibiotik intrakranial tanpa menunggu hasil kultur. Hal ini dilakukan karena membedakan meningitis bakterialis dan meningitis bukan bakteri pada awal perjalanan penyakit terkadang sulit. Beberapa indikator dapat digunakan untuk membedakan hal itu. Salah satunya adalah bacterial meningeal score (BMS), terdiri dari pengecatan gram cairan serebrospinal positif, protein cairan serebrospinal ≥80 mg/dL, neutrofil darah tepi ≥10.000 sel/mm3, riwayat kejang, neutrofil absolut cairan serebrospinal ≥1000 sel/ mm3. Tujuan. Mengetahui apakah bacterial meningeal score merupakan indikator yang baik untuk menegakkan diagnosis meningitis bakterialis akut pada bayi dan anak Metode. Uji diagnostik pada anak usia >1 bulan-18 tahun, yang dicurigai sebagai meningitis berdasarkan kriteria WHO, mulai Februari 2011 sampai dengan April 2011. Diagnosis meningitis bakterialis ditegakkan apabila hasil kultur ditemukan bakteri. Hasil. Di antara 31 anak subjek penelitian, 16 laki-laki. Semua datang dengan demam, kejang (29/31), penurunan kesadaran (15/31), dan tanda meningeal (17/31). Pengecatan gram positif pada 9/31 sampel dan kultur positif 12/31 sampel. Hasil analisis statistik didapatkan sensitivitas BMS 83,3%, spesifisitas 89,5%, nilai praduga negatif 83,3%, nilai praduga positif 89,5%, likelihood ratio positif 7,92, dan likelihood ratio negatif 0,186. Bakteri yang tumbuh dari hasil kultur adalah P. aerogenosa, S.epidermidis and Paracoccus sp, Bacillus. Sp dan Enterococcus sp. Kesimpulan. Bacterial meningeal score merupakan indikator yang baik untuk menilai meningitis bakteri pada bayi dan anak karena memiliki sensitivitas, spesifisitas, nilai praduga negatif, nilai praduga positif, likelihood ratio positif dan likelihood ratio negatif yang tinggi.